Abstract
We measured mechanics of breathing of 3 very low birth weight infants (820, 850, 940 g) who required positive pressure ventilation (2-10 breaths/min) and distending pressure. We put a pneumotachograph onto the endotracheal tube and an esophageal balloon in the mid esophagus. Each infant was studied 3 times (29-66 days). Seven studies were satisfactory. Measurements were made with the infant's head in 5 different positions, to the right, left, flexed, neutral and extended. Respiratory flow and pressure were recorded and analyzed by a computer programmed to calculate respiratory rate, tidal volume, lung compliance and work of breathing, breath by breath. Each head position was maintained for approximately 1 minute and analysis made of a period of regular breathing. At least 10 (mean = 17) breaths were analyzed. There was a 2 to 8 fold difference in the work of breathing (per liter ventilation), between the different head positions in 6 of 7 studies. The average work in the position of least and greatest work was 2280 g cm/L/min (S.D.±1240) and 6680 g. cra/L/min (S.D.±2980). The position corresponding to least work varied. Roentgenograms showed that the endotracheal tube position changed with different head positions with the tube tip moving up and down the trachea, into the main bronchi and against the wall of the trachea. We conclude that routine changes in the head position of these infants cause marked changes in the work of breathing which might prolong respiratory insufficiency.
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Wilkinson, A., Mcquitty, J., Willis, M. et al. THE EFFECT OF DIFFERENT HEAD POSITIONS ON THE WORK OF BREATHING IN VERY LOW BIRTHWEIGHT INFANTS WITH ENDOTRACHEAL TUBES. Pediatr Res 11, 581 (1977). https://doi.org/10.1203/00006450-197704000-01268
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DOI: https://doi.org/10.1203/00006450-197704000-01268